PDF(Pubmed)
Abstract：
UNASSIGNED: Nakaseomyces glabrata, formerly Candida glabrata, is an opportunistic yeast and emerging cause of human infections. The use of broth microdilution (BMD) methodologies for caspofungin (CSP) antifungal susceptibility testing (AFST) against N. glabrata is reported to be prone to high inter-laboratory variation. We aimed to compare CSP MICs of N. glabrata isolates from our institution with those obtained by the Reference Laboratory for the same isolates.
UNASSIGNED: All clinically significant N. glabrata isolates from 2019 to 2021 inclusive were reviewed. AFST was performed locally using the VITEK2 system with the AST-YS08 card, while E-tests were performed at the Mycology Reference Laboratory (MRL), and agreement between these two methods was evaluated - categorical and essential.
UNASSIGNED: Forty-one isolates were reviewed during the study period - 30 from blood cultures, seven from intra-operative theatre specimens and four from sterile site drain fluids. Despite an essential agreement of 100 % within ±2 log2 dilutions, marked discrepancies were noted in interpretative breakpoints between assays with 17 Minor and 16 Major category errors. Categorical agreement was 19.5 %, with the VITEK2 over-estimating resistance. A Mann-Whitney U-test assessed the relationship of MICs across the AFST modalities, and a statistically significant difference was noted, P<0.01, with a higher mean rank for VITKEK2 outputs.
UNASSIGNED: While the VITEK2 system is highly applicable, its performance for CSP AFST is unreliable and potentially results in the mis-classification of susceptible isolates as highlighted in our study. The use of VITEK2 AST-YS08 micafungin as a sentinel echinocandin should be explored and/or the evaluation of CSP-specific E-tests as utilized by the MRL. These methods appear more consistent and less prone to the variation seen with BMD for CSP.
UNASSIGNED: All clinically significant N. glabrata isolates from 2019 to 2021 inclusive were reviewed. AFST was performed locally using the VITEK2 system with the AST-YS08 card, while E-tests were performed at the Mycology Reference Laboratory (MRL), and agreement between these two methods was evaluated - categorical and essential.
UNASSIGNED: Forty-one isolates were reviewed during the study period - 30 from blood cultures, seven from intra-operative theatre specimens and four from sterile site drain fluids. Despite an essential agreement of 100 % within ±2 log2 dilutions, marked discrepancies were noted in interpretative breakpoints between assays with 17 Minor and 16 Major category errors. Categorical agreement was 19.5 %, with the VITEK2 over-estimating resistance. A Mann-Whitney U-test assessed the relationship of MICs across the AFST modalities, and a statistically significant difference was noted, P<0.01, with a higher mean rank for VITKEK2 outputs.
UNASSIGNED: While the VITEK2 system is highly applicable, its performance for CSP AFST is unreliable and potentially results in the mis-classification of susceptible isolates as highlighted in our study. The use of VITEK2 AST-YS08 micafungin as a sentinel echinocandin should be explored and/or the evaluation of CSP-specific E-tests as utilized by the MRL. These methods appear more consistent and less prone to the variation seen with BMD for CSP.
摘要：
■光滑的Nakaseomyces,以前的光滑念珠菌，是一种机会性酵母，是人类感染的新原因。据报道，将肉汤微量稀释（BMD）方法用于卡泊芬净（CSP）抗真菌药敏试验（AFST）。我们旨在比较来自我们机构的光滑奈瑟菌分离株的CSPMIC与参考实验室获得的相同分离株的CSPMIC。
■对2019年至2021年的所有有临床意义的光滑奈瑟菌分离株进行了审查。使用带有AST-YS08卡的VITEK2系统在本地执行AFST，虽然电子测试是在真菌学参考实验室（MRL）进行的，并对这两种方法之间的一致性进行了评估-分类和必要的。
■在研究期间审查了41个分离株-30个来自血液培养物，七个来自术中手术室标本，四个来自无菌部位的引流液。尽管在±2log2稀释度内有100%的基本一致性，在具有17个次要类别错误和16个主要类别错误的测定之间的解释性断点中发现了明显的差异。类别协议为19.5%，与VITEK2过度估计电阻。Mann-WhitneyU检验评估了跨AFST模式的中等收入国家之间的关系，并注意到统计学上的显着差异，P<0.01,VITKEK2输出的平均等级较高。
■虽然VITEK2系统非常适用，其在CSPAFST中的表现不可靠,并可能导致我们研究中强调的易感分离株的分类错误.应探索使用VITEK2AST-YS08米卡芬净作为前哨棘白菌素和/或评估MRL使用的CSP特异性E测试。对于CSP,这些方法看起来更一致且较不容易出现BMD的变化。
■对2019年至2021年的所有有临床意义的光滑奈瑟菌分离株进行了审查。使用带有AST-YS08卡的VITEK2系统在本地执行AFST，虽然电子测试是在真菌学参考实验室（MRL）进行的，并对这两种方法之间的一致性进行了评估-分类和必要的。
■在研究期间审查了41个分离株-30个来自血液培养物，七个来自术中手术室标本，四个来自无菌部位的引流液。尽管在±2log2稀释度内有100%的基本一致性，在具有17个次要类别错误和16个主要类别错误的测定之间的解释性断点中发现了明显的差异。类别协议为19.5%，与VITEK2过度估计电阻。Mann-WhitneyU检验评估了跨AFST模式的中等收入国家之间的关系，并注意到统计学上的显着差异，P<0.01,VITKEK2输出的平均等级较高。
■虽然VITEK2系统非常适用，其在CSPAFST中的表现不可靠,并可能导致我们研究中强调的易感分离株的分类错误.应探索使用VITEK2AST-YS08米卡芬净作为前哨棘白菌素和/或评估MRL使用的CSP特异性E测试。对于CSP,这些方法看起来更一致且较不容易出现BMD的变化。
